Preventive antibiotic could lower child deaths in Africa
If resistance develops against azithromycin, diseases treated by the drug, including gonorrhoea, would become harder to treat.
Giving a widely-used antibiotic to children could help end preventable child deaths by preventing infectious diseases, new research published in the New England Journal of Medicine has shown.
Researchers gave 190,000 children aged between one month to five years in selected communities in Niger, Malawi and Tanzania, either a single dose of oral azithromycin or a placebo (that was a match in taste and appearance) twice a year for two years, starting December 2014 to February 2017.
By the end of the trial, child mortality in communities where children had been given the preventive antibiotic was 14 per cent lower than in communities where children had been given a placebo.
Child mortality dropped 18 per cent in Niger where more than 10 per cent of children die before their fifth birthday.
Further, it dropped six per cent in Malawi and three per cent in Tanzania. Researchers suspect that azithromycin acts against microbes that can cause respiratory infections, diarrhoea and malaria, the three biggest killers of children under age five.
CONCERNS
There are concerns, however, that this approach could lead to antibiotic resistance.
But drawing from another programme where entire communities in some African countries are given a single dose of antibiotics, once a year, to prevent trachoma-derived blindness, the researchers suspect that even if resistance developed, it would be only to so-called macrolide antibiotics such as azithromycin and erythromycin, and not necessarily to other classes of antibiotics such as penicillin, which are used as first-line treatments for respiratory infections.
If resistance develops against azithromycin, diseases treated by the drug, including gonorrhoea, would become harder to treat.
Researchers say that if this approach were to be implemented, it should target only the populations that need it most and for a limited time. They also recommend reducing child mortality through improved nutrition, sanitation and healthcare.
“Treating only young children may select for less resistance than treating the entire community. The potential for resistance will have to be balanced against the potential to save the lives of thousands of young children,” said senior author Thomas Lietman.
He noted that the youngest children, those most vulnerable to life-threatening diseases, benefited the most from receiving azithromycin. Deaths among one to five-month-olds fell by nearly 25 per cent, nearly double the rate of the group overall.
